Health Economics

6 in 10 people in the US would like to replace the Affordable Care Act with a national health insurance program for all Americans, according to a Gallup Poll conducted on the phone in May 2016 among 1,549 U.S. adults. More >>

Total nominal US health care spending increased 5.8 percent and reached $3.2 trillion in 2015. On a per person basis, spending on health care increased 5.0 percent, reaching $9,990. The share of gross domestic product devoted to health care spending was 17.8 percent in 2015, up from 17.4 percent in 2014. Coverage expansions that began in 2014 as a result of the Affordable Care Act continued to affect health spending growth in 2015. In that year, the faster growth in total health care spending was primarily due to accelerated growth in spending for private health insurance (growth of 7.2 percent), hospital care (5.6 percent), and physician and clinical services (6.3 percent). Continued strong growth in Medicaid (9.7 percent) and retail prescription drug spending (9.0 percent), albeit at a slower rate than in 2014, contributed to overall health care spending growth in 2015. More >>

A majority of healthcare executives expect IT budgets to increase in the next two years, but doing more with less remains a major reality, according to a survey from Peak 10.
The poll of 157 C-level executives and healthcare IT pros found staffing a major worry, whether in dealing with increasing security threats or the increasing need for a data-savvy workforce. More >>

Spending on healthcare for the privately insured in the U.S. went up 4.6% in 2015, according to a new report from Health Care Cost Institute (HCCI).
The increase outpaces previous years, where such spending grew 3% in 2013 and 2.6% in 2014.
Notably, the average price of an ER visit increased 10.5% last year ($1,863) while the average acute hospital admission increased by an average of $1,000 each year of the study, landing at $19,967 in 2015. More >>

The following is a guest blog post by Santosh Varughese, President of Cognetyx, an organization devoted to using artificial intelligence and machine learning innovation to bring an end to the theft… More >>

A new market research report has concluded that given the pressures advancing the development of accountable care models, the market for solutions serving ACOs should expand worldwide, though North America is likely to lead the segment for the near future.
The report, by research firm Markets & Markets, covers a wide range of technologies, including EHRs, healthcare analytics, HIE, RCM, CDSS, population health, claims management and care management. It also looks at delivery mode, e.g. on premise, web and cloud and end-user, which includes providers and payers. So bear that in mind when you look at these numbers. That being said, providers accounted for the largest share of this niche last year, and should see the highest growth in the sector over the next five years. More >>

The Health Care Cost Institute(HCCI) reported Monday spending for people with diabetes who are covered by employer-sponsored insurance (ESI) increased at a faster pace (6%) than for people without the condition (3.2%), reaching $16,021 per capita in 2014.
The institute's 2014 diabetes healthcare cost and utilization study found spending for diabetics saw an increase of $897 from 2013, and it was partly attributed to the rise of ER visits and prescription drug use among diabetics between 2012 and 2014. More >>

U.S. States are finding the need to stretch dollars as part of the Medicaid expansion under the Affordable Care Act. Such strategies include hiring private managed care companies, shifting long-term care services to community settings and restricting use of expensive prescription drugs. More >>

It's well-known that Americans pay more for healthcare and drugs than many other nations, and a recent study confirms that the same is true for oncology drugs. A study presented at this week's American Society of Clinical Oncology's annual meeting in Chicago has demonstrated large differences in average retail prices for 23 cancer drugs in seven different countries. Prices were highest in the U.S., and lowest in South Africa and India.In a separate measure of affordability, the study found that even though cancer drugs were less expensive in low-income countries, they were less affordable to patients in those countries. More >>

New statistics released Wednesday by the Bureau of Economic Analysis of the U.S. Department of Commerce provide an update of what the U.S. spends on healthcare per person based on data from 2013, as well as what it spends to treat specific diseases and medical conditions. More >>

A supplemental health insurance plan will pay out all your out-of-pocket costs, deductibles, copays, etc. for a lump sum amount you have paid.
The entire idea behind bringing supplemental health insurance was to help people of America receive assistance in catastrophic medical situations. Why it is called catastrophic is very simple- You buy a health insurance plan and think you are sorted. Rest is the responsibility of your health insurance company. But you need to check your facts right away. There are three main terms you will need to take care of Copay, Coinsurance, deductibles together these three are called out-of-pocket costs. More >>

As Halloween approaches, the usual spate of horror movies will intrigue audiences across the U.S., replete with slashers named Jason or Freddie running amuck in the corridors of all too easily accessible hospitals. They grab a hospital gown and the zombies fit right in. While this is just a movie you can turn off, the real horror of patient data theft can follow you.
(I know how terrible this type of crime can be. I myself have been the victim of a data theft by hackers who stole my deceased father’s medical files, running up more than $300,000 in false charges. I am still disputing on-going bills that have been accruing for the last 15 years).
Unfortunately, this horror movie scenario is similar to how data thefts often occur at medical facilities. In 2015, the healthcare industry was one of the top three hardest hit industries with serious data breaches and major attacks, along with government and manufacturers. Packed with a wealth of exploitable information such as credit card data, email addresses, Social Security numbers, employment information and medical history records, much of which will remain valid for years, if not decades and fetch a high price on the black market.
Who Are The Hackers?
It is commonly believed attacks are from outside intruders looking to steal valuable patient data and 45 percent of the hacks are external. However, “phantom” hackers are also often your colleagues, employees and business associates who are unwittingly careless in the use of passwords or lured by phishing schemes that open the door for data thieves. Not only is data stolen, but privacy violations are insidious.
The problem is not only high-tech, but also low-tech, requiring that providers across the continuum simply become smarter about data protection and privacy issues. Medical facilities are finding they must teach doctors and nurses not to click on suspicious links.
For healthcare consultants, here is a great opportunity to not only help end this industry wide problem, but build up your client base by implementing some new technologies to help medical facilities bring an end to data theft. With EHRs being more vulnerable than ever before, CIOs and CISOs are looking for new solutions. These range from thwarting accidental and purposeful hackers by implementing physical security procedures to securing network hardware and storage media through measures like maintaining a visitor log and installing security cameras. Also limiting physical access to server rooms and restricting the ability to remove devices from secure areas.
Of course enterprise solutions for the entire hospital system using new innovations are the best way to cast a digital safety net over all IT operations and leaving administrators and patients with a sense of security and safety.
Growing Nightmare
Medical data theft is a growing national nightmare. IDC’s Health Insights group predicts that one in three healthcare recipients will be the victim of a medical data breach in 2016. Other surveys found that in the last two years, 89 percent of healthcare organizations reported at least one data breach, with 79 percent reporting two or more breaches. The most commonly compromised data are medical records, followed by billing and insurance records. The average cost of a healthcare data breach is about $2.2 million.
At health insurer Anthem, Inc., foreign hackers stole up to 80 million records using social engineering to dig their way into the company's network using the credentials of five tech workers. The hackers stole names, Social Security numbers and other sensitive information, but were thwarted when an Anthem computer system administrator discovered outsiders were using his own security credentials to log into the company system and to hack databases.
Investigators believe the hackers somehow compromised the tech worker’s security through a phishing scheme that tricked the employee into unknowingly revealing a password or downloading malicious software. Using this login information, they were able to access the company’s database and steal files.
Healthcare Hacks Spread Hospital Mayhem in Diabolical Ways
Not only is current patient data security an issue, but thieves can also drain the electronic economic blood from hospitals’ jugular vein—its IT systems. Hospitals increasingly rely on cloud delivery of big enterprise data from start-ups like iCare that can predict epidemics, cure disease, and avoid preventable deaths. They also add Personal Health Record apps to the system from fitness apps like FitBit and Jawbone.
Banner Health, operating 29 hospitals in Arizona, had to notify millions of individuals that their data was exposed. The breach began when hackers gained access to payment card processing systems at some of its food and beverage outlets. That apparently also opened the door to the attackers accessing a variety of healthcare-related information.
Because Banner Health says its breach began with an attack on payment systems, it differentiates from other recent hacker breaches. While payment system attacks have plagued the retail sector, they are almost unheard of by healthcare entities.
What also makes this breach more concerning is the question of how did hackers access healthcare systems after breaching payment systems at food/beverage facilities, when these networks should be completely separated from one another? Healthcare system networks are very complex and become more complicated as other business functions are added to the infrastructure - even those that don't necessarily have anything to do with systems handling and protected health information.
Who hasn’t heard of “ransomware”? The first reported attack was Hollywood Presbyterian Medical Center which had its EHR and clinical information systems shut down for more than week. The systems were restored after the hospital paid $17,000 in Bitcoins.
Will Data Thieves Also Rob Us of Advances in Healthcare Technology?
Is the data theft at MedStar Health, a major healthcare system in the DC region, a foreboding sign that an industry racing to digitize and interoperate EHRs is facing a new kind of security threat that it is ill-equipped to handle? Hospitals are focused on keeping patient data from falling into the wrong hands, but attacks at MedStar and other hospitals highlight an even more frightening downside of security breaches—as hospitals strive for IT interoperability. Is this goal now a concern?
As hospitals increasingly depend on EHRs and other IT systems to coordinate care, communicate critical health data and avoid medication errors, they could also be risking patients’ well-being when hackers strike. While chasing the latest medical innovations, healthcare facilities are rapidly learning that caring for patients also means protecting their medical records and technology systems against theft and privacy violations.
“We continue the struggle to integrate EHR systems,” says anesthesiologist Dr. Donald M. Voltz, Medical Director of the Main Operating Room at Aultman Hospital in Canton, OH, and an advocate and expert on EHR interoperability. “We can’t allow patient data theft and privacy violations to become an insurmountable problem and curtail the critical technology initiative of resolving health system interoperability. Billions have been pumped into this initiative and it can’t be risked.”
Taking Healthcare Security Seriously
Healthcare is an easy target. Its security systems tend to be less mature than those of other industries, such as finance and tech. Its doctors and nurses depend on data to perform time-sensitive and life-saving work.
Where a financial-services firm might spend a third of its budget on information technology, hospitals spend only about 2 percent to 3 percent. Healthcare providers are averaging less than 6 percent of their information technology budget expenditures on security, according to a recent HIMSS survey. In contrast, the federal government spends 16 percent of its IT budget on security, while financial and banking institutions spend 12 percent to 15 percent.
Meanwhile, the number of healthcare attacks over the last five years has increased 125 percent, as the industry has become an easy target. Personal health information is 50 times more valuable on the black market than financial information. Stolen patient health records can fetch as much as $363 per record.
“If you’re a hacker... would you go to Fidelity or an underfunded hospital?” says John Halamka, the chief information officer of Beth Israel Deaconess Medical Center in Boston. “You’re going to go where the money is and the safe is the easiest to open.”
Many healthcare executives believe that the healthcare industry is at greater risk of breaches than other industries. Despite these concerns, many organizations have either decreased their cyber security budgets or kept them the same. While the healthcare industry has traditionally spent a small fraction of its budget on cyber defense, it has also not shored up its technical systems against hackers.
Disrupting the Healthcare Security Industry with Behavior Analysis
Common defenses in trying to keep patient data safe have included firewalls and keeping the organization’s operating systems, software, anti-virus packages and other protective solutions up-to-date. This task of constantly updating and patching security gaps or holes is ongoing and will invariably be less than 100 percent functional at any given time. However, with only about 10 percent of healthcare organizations not having experienced a data breach, sophisticated hackers are clearly penetrating through these perimeter defenses and winning the healthcare data security war. So it’s time for a disruption.
Many organizations employ network surveillance tactics to prevent the misuse of login credentials. These involve the use of behavior analysis, a technique that the financial industry uses to detect credit card fraud. By adding some leading innovation, behavior analysis can offer C-suite healthcare executives a cutting-edge, game-changing innovation.
The technology relies on the proven power of cloud technology to combine artificial intelligence with machine learning algorithms to create and deploy “digital fingerprints” using ambient cognitive cyber surveillance to cast a net over EHRs and other hospital data sanctuaries. It exposes user behavior deviations while accessing EHRs and other applications with PHI that humans would miss and can not only augment current defenses against outside hackers and malicious insiders, but also flag problem employees who continually violate cyber security policy.
“Hospitals have been hit hard by data theft,” said Doug Brown, CEO, Black Book Research. “It is time for them to consider new IT security initiatives. Harnessing machine learning artificial intelligence is a smart way to sort through large amounts of data. When you unleash that technology collaboration, combined with existing cloud resources, the security parameters you build for detecting user pattern anomalies will be difficult to defeat.”
While the technology is advanced, the concept is simple. A pattern of user behavior is established and any actions that deviate from that behavior, such as logging in from a new location or accessing a part of the system the user normally doesn’t access are flagged. Depending on the deviation, the user may be required to provide further authentication to continue or may be forbidden from proceeding until a system administrator can investigate the issue.
The cost of this technology will be positively impacted by the continuing decline in the cost of storage and processing power from cloud computing giants such as Amazon Web Services, Microsoft and Alphabet.
The healthcare data security war can be won, but it will require action and commitment from the industry. In addition to allocating adequate human and monetary resources to information security and training employees on best practices, the industry would do well to implement network surveillance that includes behavior analysis. It is the single best technological defense against the misuse of medical facility systems and the most powerful weapon the healthcare industry has in its war against cyber criminals. More >>

Gary Fingerhut, Cleveland Clinic’s Executive Director of Innovation, once mentioned: “Dubai can become the international center of excellence for digitizing medicine.” He also adds: “In fact, the traditional healthcare model needs an overhaul and the Middle East might very well be the region that shows us how.” Dr.Gautam Gulati, Adjunct Professor of Medical Innovation and More >>

Medicare Part D spending on Gilead's top-selling hepatitis C drug Harvoni (ledipasvir/sofosbuvir) jumped to just over $7 billion in 2015, the most spent on any prescription drug in the program, according to figures released by the Centers for Medicare and Medicaid Services (CMS) on Monday. More >>

When Robin Chase co-founded Zipcar in 2000 she saw an opportunity to turn a world of scarcity into a world of abundance Her vision was simple Make renting a car as easy and convenient as getting cash from an ATMIn her book Peers Inc Chase describes the sharing economy as a historic opportunity to combine the best of people power with the best of corporate power Zipcar tapped the excess capacity of idle cars and made it more attractive for consumers to rent than to own The result was fewer cars on the road less congestion and lower carbon emissions More >>

The U.S. Government Accountability Office generated some minor headlines last week when it reported on how much health insurers paid in rebates to policyholders in the first two years under the Affordable Care Act’s medical loss ratio (MLR) rules.
A close read of the report, “Private Health Insurance: Early Effects of Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees,” reveals important details about how insurers spent the premium income they collected from consumers and businesses. The report shows insurers spend very little on quality improvement, that they report modest profit numbers and that MLR rules have not had caused them undue harm. More >>

A new survey shows that healthcare Chief information officers (CIOs) said they’re more likely to increase their 2017 budgets than IT professionals in other sectors.
According to a new Harvey Nash/KPMG CIO survey, out of 190 companies that replied to the survey on HIT spending, there were the following results:
52 percent of HIT CIOs said an increase in IT spending in 2017 was planned.
45 percent of CIOs across all sectors plan a budget increase.
35 percent of CIOs said HIT budgets would stay at the same levels.
13 percent indicated they would go down. More >>

By Thanh Tran, CEO, Zoeticx
CMS (Center of Medicaid and Medicare Service) continues to increase emphasis on care collaboration, ranging from Chronic Care Management (CCM) to the recent announcement from the US Surgeon General’s landmark report on alcohol, drug and health. Derived from many aspects in healthcare, the authors’ examine the challenges of integrating physical and behavioral healthcare, addressing the Care Collaboration Model outlined by CMS and the Surgeon General.
In this first part of a three part series, the authors’ begin with the interdependency between physical and behavioral health, then introduce the care collaboration and provide case scenarios that outline the challenges of today healthcare.
Interdependency Between Mental and Other Chronic Disorders
A chart from the National Center for Chronic Disease Prevention and Health Promotion identifies the co-occurrence between depression and other common chronic conditions such as diabetes, cardiovascular, and cancer chronic conditions. Research has demonstrated bi-directional links between mental disorders and chronic conditions while depression and anxiety are heightening the risks towards hypertension and diabetes. Depression roughly doubles the risk for a new Coronary Heart Disease (CHD) event. A World Health Organization chart even goes further on other mental disorders such as PTSD, drug addiction and alcoholism.
Another study showed behavior health issues affecting patient recovery as follows:
Cardiovascular – 23% affected
Diabetes – 27% affected
Cancer – 42% affected
Parkinson – 51% affected
Such interdependencies have limited solutions today due to the lack of a collaborative environment. We refer to this situation as ‘revolving door care environment’, a vicious cycle compounding effects on chronic and mental disorders. A detox center can only retain the patient for detoxification. Without collaborating with other behavioral services, the patient would come back to the same habit – either drug addiction or alcoholism.
Such depression could be from social environment or from a recent developed chronic condition such as CHD. Primary care providers would continue to address the chronic condition without knowledge of what may actually feed into the patient chronic condition; another ‘revolving door’ for the physical care environment. In short, interdependency between mental and other chronic disorders must be addressed by the collaboration between physical and behavioral care services.
Care Collaborative Model and Bi-directional Information Flow
The Care Collaborative Model (CCM) is a multi-discipline approach to healthcare provided by care providers supporting and implementing treatment with the patient at the center. A bi-directional information flow is an absolute must to put the model into operation in healthcare institutes.
Currently, health IT identifies HIE (Health Information Exchange) as the basis of information flow between care providers; however, HIE flow is uni-directional as the information is “pushed” to the HIE by care providers. Other care providers “pull” the information without ongoing feedback or notification on an updated patient medical condition.
Without a bi-directional information flow, the CCM initiative cannot be put into operation. It should also be noted that this type of push and pull operation must be supported in an EHR-agnostic environment since healthcare institutes are deployed with EHR systems from multiple vendors.
Interoperability only addresses the challenge of accessing patient medical records. Such a challenge is referred, up to now, with solutions supporting a uni-directional information flow. A care collaborative model requires more than interoperability. It requires an environment where all care providers involved in patient treatment operate in sync.
Case Scenarios
As noted in one case study, Maria Viera, age 75, takes a dozen medications to treat her diabetes, high blood pressure, mild congestive heart failure, and arthritis. After she begins to have trouble remembering to take her pills, she and her husband visit her primary care physician to discuss this and a list of other worrisome developments, including hip and knee pain, dizziness, low blood sugar, and a recent fall. Maria’s primary care doctor spends as much time with her as he dares, knowing that every extra minute will put him further behind schedule. Yet despite his efforts, there is not enough time to address her myriad ailments. She sees several specialists, but no one talks to all her providers about her care, which means she may now be dealing with conflicting recommendations for treatment, or medications that could interact harmfully. As a result, Maria is at high risk for avoidable complications and potentially preventable emergency department visits and hospital stays.
This case study brings challenges to the health care system in multiple ways:
More time from a primary care provider with limited results due to the lack of collaboration with other care providers, specialists and community services.Potential conflicting recommendations for treatment due to the lack of coordination and bi-directional medical information flows from multiple care providers and specialists.The patient risk for complications, emergency visits and hospital stays significantly increases. As a condition worsens, the patient develops symptoms for behavioral health conditions.
Today’s solution for the above scenario is to bring in the services of a care manager. It would be the care manager’s job to work with all care providers, manually “pulling and pushing” patient medical conditions and updates to all involved care providers. Error prone, high cost and low efficiency are some of today’s deficiencies for healthcare attempts in implementing and realizing a care collaborative model, as outlined by CMS.
Can Today’s Health IT System Support A Care Collaborative Model? If not, why?
EHR and EMR systems are the main ‘anchors’ of today’s health IT. Two EHR characteristics are non-starters. The first is limitations to the boundary of the health institute and uni-directional systems.
The second is the HIE (Health Information Exchange) that addresses EHR limitation with its capability to support cross health institutes, but actually further deepens the uni-directional character of EHRs. Patient medical data records are duplicated and consolidated for sharing purposes, but do not have a close loop feedback system to actively enable collaboration.
As this article focuses on the challenges in solving the interdependencies between physical and behavioral health, Part 2 will reveal the new disruptive concept in addressing CMS’s Care Collaborative Model with a well-defined patient outcome. In Part 3, the authors’ will also address how the new concept will result in better patient outcomes, net new revenue for healthcare systems and curbing the overall cost curve. More >>

With greater pressure to shift to value-based payment models, healthcare organizations are finding intelligent healthcare products and services make patient-centered, family-centered care a reality in the new “outcome economy.”
According to TechTarget, the “outcome economy is an economy contingent on the marketing, pricing and selling of goods and services based on the results or outcomes they produce for customers, rather than on an item or service's face value. The trend toward an outcome-based economy is in large part enabled by digital technologies, including hardware sensors, cloud-based analytics and ubiquitous bandwidth.”
Gartner forecasts 6.4 billion connected things will be in use worldwide in 2016, up 30 percent from 2015, and 5.5 million new things will get connected every day. In the enterprise, Gartner considers two classes of connected things: generic or cross-industry devices that are used in multiple industries and vertical-specific devices that are found in particular industries. More >>

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HealthcareGuys News is all about providing articles related to healthcare topics assembled and curated from selectively picked blog sites. Apart from providing the content, the site also provides different statistics and analytics like how many times the article was Tweetted, shared in Facebook or LinkedIn, liked by the healthcare enthusiasts, etc. The best part is, we can get to the most trending articles for each day, for the week, month, quarter or for a whole year based on the share count.